Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service

CPT 52005 is the billing code for "Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service". Cystourethroscopy with ureteral catheterization for diagnostic or therapeutic purposes

Medicare pays approximately $275.27 for CPT 52005 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 52005 has a total RVU of 6.74, broken down as: Work RVU 3.00, Practice Expense RVU 3.50, and Malpractice RVU 0.24. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 52005 include: Cystoscopy performed documented; Ureteral catheterization documented; Findings documented; Patient response to procedure. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 52005: Includes cystoscopy and ureteral catheterization. May include irrigation/instillation Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 52005 include: 59 (Distinct procedural service when multiple procedures performed), 50 (Bilateral procedure), LT (Left side). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 52005 is Typically 20-30 minutes. Time-based codes require documentation of the actual time spent providing the service.